Silent (Masked) Otitis Media Definition, Symptoms, Diagnosis and Treatment
Silent (Masked) Otitis Media
Definition of Silent (Masked) Otitis Media
• silent otitis media (SOM)
• masked middle ear inflammation
• secretory otitis media
• serous otitis media
• silent otitis media
• masked otitis media
• serous otitis media
• otitis media with effusion (OME)
Serous Otitis Media Definition Video:
Ear Ventilation Tube (T-tube) Video:
Valsalva Maneuver Video:
Adenoid Hypertrophy Definition and Treatment Video:
Adenoidectomy Operation (Adenoid Removal) Video:
Silent Otitis Media TerminologyIt is important to understand the difference between effusion otitis media and other forms of middle ear infection. Otitis media is a general term defined as otitis media, referring to a specific etiology or pathogenesis. Since all the pneumatized cavities of the temporal bone are contiguous, inflammation in the middle ear may reach the other 3 areas, causing inflammation: mastoid, perilabyrinthine air cells and petroz apex. The term otitis media is often used to describe any of the diseases associated with acute otitis media (AOM), recurrent acute otitis media (RAOM), otitis media with effusion and chronic otitis media (COME) with effusion.
Chronic Silent Otitis MediaThis condition, which is characterized by a fluid behind the membrane, can cause problems such as structural changes in the eardrum, mastoiditis and the emergence of cholesteatoma in the later period. Since the tympanic membrane is intact in relation to this disease called chronic silent middle ear inflammation, chronic pathology near the middle ear may not be detected and complications and sequela risk may be increased due to the lack of clinical treatment. The concept of silent otitis media may be particularly overlooked in children under 2 years of age, because the symptoms of the disease in these groups of patients may not be recognized by families. Diagnosis and treatment delay may occur due to the fact that the symptoms related to the disease are less or less easily expressed (eg, a congestion sensation in the ear that can be confused with earwax).
How Does Silent Middle Ear Inflammation Occur?After acute inflammation is resolved, otitis media (OME) with effusion may occur during the recovery period of acute otitis media (AOM - acute otitis). Among children with acute otitis media, 45% had persistent effusion after one month, and this number decreased to 10% after 3 months.
There are two basic theories of acute otitis media:
1. The classical explanation suggests that Eustachian tube dysfunction is a necessary premise. The Eustachian tube is traditionally defined to provide 3 main functions: balancing the pressure between the middle and the outer ears, clearing the secretions and protecting the middle ear. A variety of conditions can be caused by dysfunction, anatomical obstruction (as in the case of nasal growth), allergy, upper respiratory tract infection, or inflammation secondary to trauma.
If the eustachian tube dysfunction is persistent, a negative pressure occurs in the middle ear due to the absorption and / or diffusion of nitrogen and oxygen into the mucosal cells in the middle ear. If the negative pressure is present for a sufficiently long period and of appropriate size, it derives the transudate from the mucosa and ultimately leads to serous, essentially sterile effusion accumulation. Because the Eustachian tube is dysfunctional, the effusion becomes a stable ideal environment for the growth of bacteria and acute otitis media.
2. As the new theory, it describes the inflammation of the middle ear mucosa caused by a response to bacteria already present in the middle ear. Inflammatory mediators released as a result of bacterial antigenic challenge induce upregulation of mucin genes. The production of a mushroom-rich effusion then provides a broad environment for bacterial growth and acute otitis media. There are studies showing that there are moist changes in oxidative stress in patients with otitis media with effusion. The investigators showed significant improvement not at the normal level of oxidants after the ventilation tubes were placed. However, the role of antioxidants in the treatment of otitis media with effusion has not yet been fully investigated.
Eustachian Tube Problems Are Seen as The Most Common Cause of Middle Ear FluidsEustachian tube dysfunction is almost universal in otitis media with effusion regardless of the cause of acute otitis media. In other evidence, the attachment of the Eustachian tube in animals always leads to the formation of a permanent middle ear effusion. After acute inflammation and bacterial infection are resolved, the failure of the middle ear clearance mechanism allows the middle ear effusion to continue. Many factors have been implicated in the failure of the cleansing mechanism, including ciliary dysfunction, for example, mucosal edema; hyperviscosity of effusion; and possibly a negative pressure gradient.
Otitis Media With Effusion Does Not Necessarily Occur Following Acute Otitis Media!It may also occur as a silent middle ear infection alone. theories describing the development of middle ear effusion include the release of fluid from the inflamed middle ear mucosa. This theory suggests that the middle ear mucosa was previously sensitized by exposure to bacteria, and occasionally to continue antigenic stimulation from the reflux to induce effusion. Again, multiple studies have shown that the same flora bacterium is present in otitis media with effusion as in acute otitis media; these findings confirm that the idea of a "effusion is sterile", which was once believed, is false.
Risk Factors For Silent Otitis MediaEnvironmental factors, age and dysfunction of Eustachian tube have been associated with otitis media with effusion.
Environmental factorsIn addition to actual pathogens, environmental factors have been strongly associated with increased prevalence of otitis media with effusion in a number of epidemiological studies. These factors include bottle feeding, supine supine feeding, having a brother with otitis media, joining the day care (crowded nursery environment is a very big risk factor for children), living in an environment with high allergen rates, low socio-economic status, living in the home (smoking next to children, facilitating the emergence of fluid in the middle ear in children!) and having a family history of otitis media.
AgeAge is another prominent factor in the development of otitis media with effusion. The eustachian tube of the baby has an almost horizontal orientation (relative to the ground), and after a few years (as in adults) it is at a 45 ° angle. In addition, the size and shape of the Eustachian tube at the time of delivery is also unfavorable for the ventilation of the middle ear, unlike the adults.
The frequency of silent otitis media is highest in children aged 2-4 years, and as expected with the prevalence of otitis media with effusion, there is a significant decrease in the frequency of children older than 6 years.
In adults, it is important to recognize unilateral otitis media with effusion. This entity should be considered as a nasopharyngeal mass until it is proved to be exact. In the case of long-lasting serous otitis media in a single ear (in the case of adult unilateral middle otitis media), nasopharynx cancer (nasopharynx tumor) should be considered in the differential diagnosis.
Silent middle ear inflammation is more common in young children than older children or adults due to:
• The tube is shorter, more horizontal and flat, making it easier for bacteria to enter.
• The tube is more flexible and has a smaller opening that is easier to clog
• More frequent colds are seen because the immune system takes time to recognize cold viruses in young children and the emergence of immune response
Eustachian tube dysfunction
In patients with cleft palate, silent middle ear inflammation may occur!
Other risk factors for silent otitis media
Corrected Incorrect Expression "Middle Ear Fluid Does Not Arise From Fluid Leakage From Outside To Ear"
How Does The Silent Otitis Media Behave?
Following spontaneous extrusion of ear ventilator tubes (which spontaneously excretes ear plugs) for the treatment of silent otitis media (20 to 50% of patients), recurrence of otitis media with effusion is seen and potentially combined with pressure balancing tubes and, in most cases, simultaneous adenoidectomy is required.
Symptoms of Silent Otitis Media
Symptoms are usually mild or minor. It may vary according to the age of the child.
A common symptom of silent otitis is a hearing problem. Behavioral changes in younger children may be a sign of hearing problems. For example, children can turn on the television louder than usual. They can also pull or mix their ears.
Older children and adults with silent otitis media often describe the voice as muffled. They can feel the fluid is full of fluid.
Diagnosis of Silent Otitis Media
|Acute Otitis Media|
|Acute Otitis Media|
Treatment of Silent Otitis Media
Silent otitis media often tend to recover spontaneously. It usually occurs after the treatment of acute otitis media in small children and can resolve within a few weeks. However, the risk of developing chronic, silent otitis media increases in children living in smoking houses, especially those with large or large fleshy nursery settings.
The most effective treatment for silent middle ear infections is the ear ventilation tubes that are placed in the eardrum and allow internal and external pressure equalization. In children with silent otitis media and not recovering for more than 3 months, nasal surgery is usually performed in addition to ear ventilation tube. At the beginning of the page there is a video of the nasal surgery video and the extraction of the ear tube. Removal of adenoids may also help to treat or prevent silent otitis media.
Planning of insertion of an ear ventilator tube in the presence of a more than 40 dB conduction type of hearing loss accompanied by chronic silent otitis media (with prolonged duration of ear fluid beyond 3 months despite treatment) is required.
How Can You Prevent Silent Otitis Media in Your Child?
Pneumonia and influenza vaccine can make you more resistant to silent otitis media. They can prevent ear infections that increase the risk of silent middle ear inflammation.
Complications of Silent Otitis Media
Since otitis media with effusion does not have inflammation in acute otitis media, its complications are few. As mentioned above, the most important complications and reasons for treatment are delay in hearing loss and potential language development. However, persistent effusion provides an extraordinary environment for the growth of bacteria. Permanent structural changes in the eardrum is the most common problem; it is very rare to see the risks associated with infection of the intracranial and brain membranes in normal chronic otitis media.
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